CPH Newsletter - Volume 07 - April - June 2007


Alex Christie practising homeopath and allergy consultant

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Welcome to the June newsletter written by Alex Christie. For those of you who are new to this newsletter, Alex writes one every month for Cph on a different subject or subjects. You are welcome to write to her and suggest a topic, as she has several that she is gradually working through already!

To all readers who were expecting the April and May newsletters, Alex explains; the reason I have been unable to provide you with the last two newsletters is that my mother-in-law has rapidly developed Alzheimer’s and Dementia over the last few months, which I have decided to make the topic of this newsletter.

When we were told that that my mother-in-law’s MRI scan revealed that she had both vascular dementia and Alzheimer’s we didn’t know what this meant. It has been a sharp learning curve for my husband and myself over the last few months.

My mother-in-law has always rather liked using threats to get her own way. But the usual “I’ll be dead soon, you must come and see me,” accelerated into “I have taken an overdose of pills and committed suicide; if you don’t come immediately you will never see me again.” We have learned that at such times she feels lonely and wants some company. She has a live-in carer for 8 hours a day. However, when the carer takes her afternoon and weekend breaks, my mother-in-law doesn’t know what to do with herself. The suicide threats increased to every afternoon and she started to believe someone was about to murder her. Paranoia is a common symptom of Alzheimer’s.

When my mother-in-law started clinging to the carer and screaming whenever she wanted to take her break we decided she needed extra support and booked her into a hospital day centre for people with dementia. They could only take her two days a week by the time they found her lost file. However, my mother-in-law no longer has any social skills with which to communicate to other people and she finds it hard to participate in any of the organized activities. Her memory has declined to such an extent that she does not remember much about her past, what her husband did, she cannot name more than two animals, is unable to draw the face of a clock, no longer understands anything on the television or radio, and she cannot dress or undress herself, or walk unaided. She is incontinent, sometimes doubly.

I asked the NHS and Social Services how we could arrange for her to be put in a home where she could have 24-hour care at the hands of experts as her carer was about to suffer a nervous breakdown. We were informed that this would not be in her best interest although it might be in ours. She would be better in her own home. Her carer took a holiday at this point. 24 hour home care costs around £1,200 per week and more than one person is needed as my mother-in-law’s mental age is now around that of a 3 year old’s. The quality of care provided depends entirely on the individual carer. Not many are willing to take on an incontinent person with massive mood swings.

Care homes cost between £700 if they are a charity and £950 per week. Fortunately, we found a small care home reasonably close by which would take my mother-in-law as a private patient. That evening she phoned us to ask how she should get home. She hadn’t understood that she was staying there, even though we had explained this to her and unpacked her belongings in front of her. It is Social Services who decide if she can stay in the home permanently, and the home decides if they will accept her after a 3-week trial period. If she attacks either residents or staff as she did her carer this will be unlikely. Since even with a live-in carer we have been spending between half and three days a week dealing with the almost daily crises for the past three months, we await the decision in 3 week’s time with bated breath.

 

Dementia


What is dementia?
The term ‘dementia’ is used to describe the symptoms that occur when the brain is damaged by specific diseases. Someone with dementia might have problems remembering, solving problems or concentrating. These symptoms get worse over time. However, each person experiences dementia in his or her own way, and the speed at which dementia progresses can vary.

Are there different types of dementia?
Over 750,000 people in the UK have dementia. About half of these people have a type of dementia called Alzheimer’s disease. This is caused by the build-up in the brain of structures called ‘plaques’ and ‘tangles’, which lead to the death of brain cells.

Vascular dementia is another common type of dementia.  Some people with vascular dementia also have Alzheimer’s disease. This is called mixed dementia. Current estimates indicate that about 20 per cent of people with dementia have vascular dementia or mixed dementia, but further research may show that many
more people are affected by mixed dementia.

What is vascular dementia?
Vascular dementia is a type of dementia caused by problems with the supply of blood to the brain.  Sometimes, the general term vascular dementia is not used and a more specific name is given to describe the type of damage in the brain – for example, multi-infarct dementia.

Vascular dementia is not a normal part of ageing.  Although it is more common in older people, it can develop at any age. To understand vascular dementia, it is necessary to understand why the brain needs a good supply of blood and how blood reaches the brain.

How does blood reach the brain?
The brain needs a good supply of blood; blood keeps the brain cells healthy and functioning properly. Blood is delivered to the brain by a network of arteries and blood vessels. This is called the vascular system. If the vascular system becomes damaged or blocked, blood is prevented from reaching the brain. This causes brain cells to die and can lead to the onset of vascular dementia.  Two pairs of arteries supply blood to the brain. As the blood travels deeper into the brain it enters smaller and smaller blood vessels.  A healthy blood vessel is like a brand new hosepipe: the insides are smooth and the walls are flexible. This helps blood to travel quickly and easily to where it needs to go.  Problems arise when:

These problems prevent blood flowing easily to all areas of the brain.

Summary
Vascular dementia is the second most common form of dementia.  Vascular dementia is caused by problems with the supply of blood to, or within, the brain People may have mixed dementia – both vascular dementia and Alzheimer’s disease.

Vascular dementia is a complicated disease. Symptoms can be varied and depend on which parts of the brain have been damaged and how severe the damage is.  Symptoms may develop suddenly or more gradually. The person may be affected by some symptoms but not by others. It is also possible for symptoms to get better or worse from day to day.

Someone in the early stages of vascular dementia may not experience memory problems and their personality may be unaffected. This means that people with vascular dementia often have an insight into their condition for much longer than people with other forms of dementia. Depression often accompanies vascular dementia. This can cause the person to feel sad, hopeless or less energetic. Depression is a physical condition caused by chemical changes in the brain. It is not something someone can just ‘snap out of’ and it needs to be properly treated. Treatment can lead to improvements in cognitive function.  Other early symptoms may include:

between us in the early stages – I didn’t realise he couldn’t understand. His co-ordination and spatial awareness were affected and he had real trouble with sequential tasks like bringing a kitchen chair back in from the garden or following a recipe.’  ‘I know that if I’m not well, my mental capacity goes down the drain. That’s why it’s important to keep healthy and treat any infections.’

How do symptoms progress?
The prognosis for someone with vascular dementia depends on the factors causing the damage to their brain and the location of the damage.  People with vascular dementia and the people close to them often describe the development of symptoms as being marked by sudden or ‘stepped’ changes. By that, they mean symptoms develop unexpectedly or suddenly get significantly worse. The person may then remain stable for a while until there is another abrupt change in their behaviour. This pattern often occurs when vascular dementia is caused by strokes.  However, in some circumstances the progression of the disease is more gradual, as it is with Alzheimer’s disease.  This is more characteristic of sub-cortical vascular dementia caused by small vessel disease.  As the disease progresses, other symptoms may develop.  These are often similar to the symptoms caused by other
forms of dementia, and may include:

Summary
Memory loss may not be the first symptom of vascular dementia.  Symptoms may develop suddenly and deteriorate in steps.  Depression is common in people with vascular dementia.  The person’s personality may not be badly affected.  ‘He did get worse, physically and mentally, but his personality remained. He was still a private person, still a gentleman, still very caring – and he still needed to be treated as an adult.’

Just as there are different types of cancer, there are different types of vascular dementia. Multi-infarct dementia was the first kind of vascular dementia to be identified and it is the type that most people have heard of. However, there are two other main types: single infarct dementia and sub-cortical vascular dementia. The difference between these types depends on whether they are caused by stroke or small vessel disease, and on which part of the brain has been damaged. 

Stroke related dementia (multi-infarct and single-infarct dementia)
A stroke is the term used to describe permanent brain damage that has occurred because of an interruption in the brain’s supply of blood. This can be caused by a blockage in, or leak from, a blood vessel feeding that part of the brain. The effects of a stroke vary from person to person and depend on how much of the brain is damaged and what that part of the brain is responsible for.  A single stroke can be enough to cause dementia if it is very large or if it affects a very important part of the brain. This type of vascular dementia is known as single-infarct dementia. The word ‘infarct’ means ‘damaged area’. Research shows that more than a quarter of people who have a stroke go on to develop vascular dementia within three months*. It is, therefore, important that action is taken to prevent further strokes.

Vascular dementia can also be caused by lots of small strokes. This condition is called multi-infarct dementia. Sometimes the strokes are so small that the person does not notice any symptoms or the symptoms are only temporary.  However, the brain damage caused by lots of these small strokes can build up, resulting in the symptoms of dementia.

*Tatemichi, TK et al (1990). ‘Dementia in stroke survivors in the Stroke Data Bank cohort.  Prevalence, incidence, risk factors and computed tomographic findings’. Stroke. 21: 858-866

Types of vascular dementia
‘The most surprising thing for people was that there were many different types
of dementia and, really, it was quite a surprise for me too.’

Stroke related dementia
The symptoms of stroke related dementia may appear suddenly. Over a period of time, the person may have further strokes which result in cognitive and, frequently, physical disabilities

Small vessel disease related dementia
Small vessel disease related dementia tends to be more like Alzheimer’s disease, developing slowly over time.

What are transient ischaemic attacks?
A transient ischaemic attack (TIA) is very similar to a stroke in that there is an interruption in the blood supply to, or in, the brain. When the blood supply is only temporarily disrupted, it is referred to as a TIA. This means that sudden symptoms, such as slurred speech, weakness on one side of the body or blurred vision, should disappear within 24 hours. This does not mean they should be ignored as they can cause small amounts of damage to the brain. A TIA also gives a warning to the person that they are at risk of further strokes.  Small vessel disease related dementia (sub-cortical vascular dementia) In some cases, the onset of dementia is more gradual and is not caused by stroke. Damage to the very small blood vessels deep in the brain (the sub-cortex) is called small vessel disease. This can cause sub-cortical vascular dementia.

The symptoms generally develop more gradually, and cognitive problems are often accompanied by difficulties with walking. Since the onset of subcortical vascular dementia is similar to Alzheimer’s disease, it can make diagnosis difficult. Specialists often state that people with sub-cortical vascular dementia take longer to remember things but do remember correctly eventually. This is less likely to be the case with Alzheimer’s disease.  Sub-cortical vascular dementia can also be accompanied by stroke.  Doctors may sometimes use other terms, such as Binswanger’s disease, to describe small vessel disease.

‘The suggestion is that the series of ‘faints’ I had may have been TIAs.  My doctor tells me it’s the brain’s way of warning you that you are at risk of a stroke. I’m now on medication to try and stop it happening again.’

Summary
Multi-infarct dementia is one type of vascular dementia, but there are others.  Damage to the brain caused by stroke or small vessel disease can lead to vascular dementia.  A diagnosis of mixed dementia means thatdamage to the brain may have been caused by Alzheimer's disease aswell as stroke or small vessel disease.

Gender
Vascular dementia is more common in men than women.  This may be because common risk factors for vascular dementia, such as heart problems and high blood pressure, are more common in men than women. 

Genes. Some medical conditions, such as high blood pressure and diabetes, run in families and can put you at higher risk of developing vascular dementia. These conditions are discussed in more detail below.

We all have a gene called apolipoprotein E (ApoE) in our blood and brains. This gene comes in three forms: ApoE2, ApoE3 and ApoE4. ApoE4 has been associated with a higher risk of developing Alzheimer’s disease, and this may also be true of vascular dementia. Further research is needed.

Medical history. Specific conditions that affect the heart, arteries or blood circulation can increase a person’s chances of developing vascular dementia. This is because the inside of the vessels becomes damaged; the heart pumps irregularly or pushes blood too forcefully into the blood vessels; or the blood thickens or clots too easily. Such conditions include:

Factors that may cause vascular dementia

It is vital that these conditions are identified, monitored and treated at an early stage as they may influence the progression of vascular dementia as well as its development in the first place.


Ethnic background
People from some countries may be at particular risk.  People from India, Bangladesh, Pakistan and Sri Lanka have higher rates of coronary heart disease (due to their genes) than other populations. The link between the heart and brain means vascular dementia is more likely for these people.  People with an African-Caribbean ethnic background are more likely to have diabetes and high blood pressure than people from a European background. This may be because of a combination of genetic and lifestyle factors.  It means that vascular dementia is also more common for people with this background.

Lifestyle
You are more likely to develop vascular dementia if you:

Summary
Conditions affecting the heart, arteries or the circulation of blood to thebrain can cause vascular dementia. Stroke is a major risk factor for vascular dementia; more than a quarter of people who have a stroke develop vascular dementia within three months.  Lifestyle factors thatincrease cholesterol and blood pressure may also play a part in thedevelopment of the disease.

It is important to see your GP as soon as possible if you think that you, orsomebody you are close to, has the symptoms of vascular dementia.  The GP will ask lots of questions and carry out a physical examination.  You may be referred to a consultant for brain scans and cognitive assessment. It may be difficult to differentiate between Alzheimer’s disease and vascular dementia – some people have both Investigations should aim to identify risk factors, such as high blood pressure, and not just dementia.

Steps You Can Take to Remain Healthy into Old Age:

Orthodox Treatment for the symptoms of dementia
There are several drugs available for the treatment of cognitive impairments. However, these are currently licensed only for use in Alzheimer’s disease. Further research is required but evidence suggests that these drugs may be effective for some people with vascular dementia or mixed dementia.  The Alzheimer’s Society is campaigning for all four anti-dementia drugs (Aricept, Reminyl, Exelon and Ebixa) to be made available for people with vascular dementia as well as people with Alzheimer’s disease. For further information on drug treatments for dementia, please see the Alzheimer’s Society information sheet Drug treatments for Alzheimer’s disease – Aricept, Exelon, Reminyl and Ebixa.

More than half of people with vascular dementia also have depression. Medical and/or non-pharmacological treatments can be used to treat depression. It can be difficult to diagnose depression in people with dementia because some of the symptoms of depression and dementia are so similar, and because people with
dementia may have difficulty explaining how they feel.

For further information see the Alzheimer’s Society information sheet Depression.

Alzheimer's Disease


Alzheimer's disease is the most common form of dementia, a group of disorders that impairs mental functioning. (Dementia literally means loss of mentation, or thinking.) At the moment, Alzheimer's disease is progressive and irreversible. Abnormal changes in the brain worsen over time, eventually interfering with many aspects of brain function.

Memory loss is one of the earliest symptoms, along with a gradual decline of other intellectual and thinking abilities, called cognitive functions, and changes in personality or behaviour. Alzheimer's disease advances in stages, progressing from mild forgetfulness and cognitive impairment to widespread loss of mental abilities.

In advanced Alzheimer's, people become dependent on others for every aspect of their care. The time course of the Alzheimer's disease varies by individual, ranging from five to 20 years. The most common cause of death is infection.

Alzheimer's Symptoms

Alzheimer's symptoms and warning signs may vary. It's not uncommon to occasionally forget dates or lose items, and these events may become more common as we age. But while occasional memory slippage may be a normal consequence of getting older, Alzheimer's disease is not. If memory problems interfere with one's day-to-day activities, it may be time to seek a doctor's help.

Alzheimer's Symptoms Include:

Some change in memory is normal as we grow older, but the symptoms of Alzheimer’s disease are more than simple lapses in memory.  People with Alzheimer’s experience difficulties in communicating, learning, thinking and reasoning. This causes problems severe enough to have an impact on an individual's work, social activities and family life.

The Alzheimer's Association has developed a checklist of common symptoms to help you recognize the difference between normal age-related memory changes and possible warning signs of Alzheimer’s disease.

There’s no clear-cut line between normal changes and warning signs. It’s always a good idea to check with a doctor if a person’s level of function seems to be changing.

10 warning signs of Alzheimer's:

1. Memory loss. Forgetting recently learned information is one of the most common early signs of dementia. A person begins to forget more often and is unable to recall the information later.
What's normal? Forgetting names or appointments occasionally.

2. Difficulty performing familiar tasks. People with dementia often find it hard to plan or complete everyday tasks. Individuals may lose track of the steps involved in preparing a meal, placing a telephone call or playing a game.
What's normal? Occasionally forgetting why you came into a room or what you planned to say.

3. Problems with language. People with Alzheimer’s disease often forget simple words or substitute unusual words, making their speech or writing hard to understand. They may be unable to find the toothbrush, for example, and instead ask for "that thing for my mouth.”
What's normal? Sometimes having trouble finding the right word.

4. Disorientation to time and place. People with Alzheimer’s disease can become lost in their own neighborhood, forget where they are and how they got there, and not know how to get back home.
What's normal? Forgetting the day of the week or where you were going.

5. Poor or decreased judgment. Those with Alzheimer’s may dress inappropriately, wearing several layers on a warm day or little clothing in the cold. They may show poor judgment, like giving away large sums of money to telemarketers.
What's normal? Making a questionable or debatable decision from time to time.

6. Problems with abstract thinking. Someone with Alzheimer’s disease may have unusual difficulty performing complex mental tasks, like forgetting what numbers are for and how they should be used.
What's normal? Finding it challenging to balance a checkbook.

7. Misplacing things. A person with Alzheimer’s disease may put things in unusual places: an iron in the freezer or a wristwatch in the sugar bowl.
What's normal? Misplacing keys or a wallet temporarily.

8. Changes in mood or behavior. Someone with Alzheimer’s disease may show rapid mood swings – from calm to tears to anger – for no apparent reason.
What's normal? Occasionally feeling sad or moody.

9. Changes in personality. The personalities of people with dementia can change dramatically. They may become extremely confused, suspicious, fearful or dependent on a family member.
What's normal? People’s personalities do change somewhat with age.

10. Loss of initiative. A person with Alzheimer’s disease may become very passive, sitting in front of the TV for hours, sleeping more than usual or not wanting to do usual activities.
What's normal? Sometimes feeling weary of work or social obligations.

The difference between Alzheimer's and normal age-related memory changes

Someone with Alzheimer's disease symptoms

Someone with normal age-related memory changes

Forgets entire experiences

Forgets part of an experience

Rarely remembers later

Often remembers later

Is gradually unable to follow written/spoken directions

Is usually able to follow written/spoken directions

Is gradually unable to use notes as reminders

Is usually able to use notes as reminders

Is gradually unable to care for self

Is usually able to care for self

Causes of Alzheimer’s

  1. Aluminium toxicity ha been found to increase the chances of Alzheimer’s (AD), even when the source of this is natural aluminium found in water.  A study carried out in southwest France where high levels of natural aluminium in water was found to more than double the number of AD cases.  In areas where the water was alkaline or had high levels of silica, even when natural aluminium levels were high in the water there was no increase in AD cases.

  2. High levels of copper, zinc and mercury have also been found to increase susceptibility to AD. The metals are thought to create an oxidative inflammatory response in the brain, causing the brain cells to clump into the disease’s characteristic neural plaques.

  3. High levels of homocysteine, best known as a marker for heart disease, have been found in AD sufferers.  It is thought that this can also contribute to the likelihood of developing AD, possibly because it is toxic to brain cells as it is involved in an inflammatory mechanism.

Natural Steps to Prevent Alzheimer’s

  1. Drinking wine regularly in moderation can halve your risk.
  2. Coffee reduced AD risk by one third.
  3. Have your amalgam fillings removed by a holistic dentist.
  4. Get yourself tested for metal toxicity.  There are a whole group of nutritional supplements that can detox metals from our body.  Metabolics supplies a range of these.
  5. Take a good selenium supplement.  A 9-year study showed that those with the lowest selenium levels had the greatest cognitive decline.
  6. Take an omega 3 supplement or eat fatty fish three times a week – both contain the essential fatty acid DHA.  A study showed that elderly people with relatively high DHA levels almost halve their risk of Alzheimer’s.
  7. Supplement with folic acid, or choose foods naturally high in folic acid such as green, leafy vegetables.  High folic acid levels destroy harmful homocysteine. 
  8. Exercise regularly.  Exercising three times a week reduces the risk of AD by around 30%.
  9. If you are not exercising regularly, drink 3 glasses of fruit or vegetable juice a week, it reduces your risk of AD threefold.
  10. Have your water supply checked for aluminium (it’s a free service from your water provider).  If it contains more than 0.1mg/L of aluminium and has a pH of less than 7, drink mineral water containing high levels of silica to neutralize the effects of aluminium.

Alternative Treatments for Dementia

  1. Salvia officinalis (sage) has anticholinergic effects similar to Aricept’s.  In a recent trial people with mild-to-moderate AD maintained better mental functioning on 60 drops of sage oil a day than on the drug Aricept,
  2. Lemon balm binds to brain receptors believed to be involved with anxiety, which is so often experienced by AD sufferers.
  3. Ginkgo Biloba benefits virtually all AD patients to some degree, and about one third of them significantly.  Recommended dosage is 240mg daily of the extract named EGb 761.  Gingko may help prevent the onset of AD, although there are no studies to prove this.
  4. Curcumin is being investigated as a potential anti-AD herb after it was recognized that people in India have a lower rate of AD.  UCLA have shown that curcumin can repair brain cells damaged by AD.
  5. Traditional Chinese Medicine has two herbal combinations for AD:
  1. Huperzia serrata a Chinese herb is being investigated.  A moss called huperzine alpha was tested on over 200 Chinese with mild-to-moderate AD and the results were “remarkable”.  After taking 400mcg for less than three months 60% were observed to be clinically “on the mend”.
  2. Acupuncture is used in China for AD.  (WDDTY)
  3. Homeopathic remedies such as mercury, aluminium, plumbum etc can also assist in detoxing metals.
  4. There are various homeopathic remedies for Alzheimer’s and Dementia.

Further information about vascular dementia, the underlying conditions and where to get help and support is available on the Alzheimer’s Society website at www.alzheimers.org.uk/vasculardementia. There is also an online discussion forum where you can share your experiences and ask questions.

Other specialist organisations you may find useful include:

Stroke Association
240 City Road
London EC1V 2PR
Stroke Helpline 0845 3033 100 (9am-5pm Mon-Fri)
Email info@stroke.org.uk
Website www.stroke.org.uk

Heart UK
7 North Road
Maidenhead
Berkshire SL6 1PE
Telephone 01628 628 638
Email ask@heartuk.org.uk
Website www.heartuk.org.uk

Diabetes UK
10 Parkway
London NW1 7AA
Telephone 0845 120 2960 (9am-5pm Mon-Fri)
Email info@diabetes.org.uk
Website www.diabetes.org.uk

British Heart Foundation
14 Fitzhardinge Street
London W1H 6DH
Telephone 020 7935 0185
Email internet@bhf.org.uk
Heart Information Line: 08450 70 80 70
(9am-5pm Mon, Tues, Fri, 8am-6pm Wed, Thurs)
Website www.bhf.org.uk

Blood Pressure Association
60 Cranmer Terrace
London SW17 0QS
Telephone 020 8772 4994
Website www.bpassoc.org.uk

  1. To find a kinesiologist in your area contact Metabolics 01380 812799
  2. To find a homeopath in your area contact either:

Recommended reading


Recommended reading (available from Amazon.co.uk)

References

  1. www.alzheimers.org.uk/vasculardementia
  2. What Doctors Don’t Tell You, May 2007, Vol 18, No 2

Stockists


• Helios Remedies: Offer a full range of remedies in all potencies are available. Visit their site https://www.helios.co.uk/dispensary.html

Recommendations


• Books: Available from Amazon.co.uk.
• Helios Remedy Kits: Available from Helios Homeopathic Suppliers, 8 New Row, London, WC2N 4LJ . Phone 7379 7434, or from Neal’s Yard Remedies, or www.helios.co.uk <http://www.helios.co.uk>
• Alex Christie is a qualified Homeopath (LCHE), a member of the Alliance of Registered Homeopaths (ARH) and a member of the British Complementary Medicine Association (BCMA). Alex specializes in Candida and Allergy relief treatment and can be contacted or visited at her Barnsbury Studio or Neals Yard Practice in London. E-mail Alex for a consultation , Phone 020 7609 1352 or visit her web site for more information.

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Further Resources of interest


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Support Your Supplements!


The EU is now working to set maximum permitted levels for nutrients in food supplements.  This is your chance to help make a difference.  Please take a little of your time to help us keep our vitamins and minerals at safe and beneficial dose levels.

The EU Commission will set these levels towards the end of 2007, and the early signs suggest they will be set very much lower than those already available in the UK and some other member states.  Could you find time to write to the commissioner today asking him to ensure levels are set as high as possible and in accordance with the levels that good science confirms are safe?

By taking steps now we can avoid the EU, or rather the Pharmaceutical Companies, depriving us of the right to take the supplements that will improve our health (and enable us to avoid having to take drugs).

On the following website there is a petition you can sign and a prepared letter you can send to the Commissioner on the left hand link.  

www.consumersforhealthchoice.com/

Once again may I take this opportunity to thank you for your continued interest, and I look forward to staying in touch with you regularly. Remember, if you would like me to cover any specific topic, please e-mail me and I will try and do so in one of our future newsletters.

Yours in health,

on behalf of
the College of Practical Homeopathy
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